Prospective, double-blind, comparative fast-tracking trial in an academic emergency department during a period of limited resources

Kilic, Yakup; Agalar, Fatih; Kunt, Mehmet Mahir; Çakmakçı, Metin

doi:10.1097/00063110-199812000-00004

Cited by 17 publications

(18 citation statements)

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“…Given there was a median of 20 patients seen in fast track per day during the study period, this finding is important as it indicates 5.3 h (320 minutes) of saved clinical resources and improved access to emergency care per day. Reductions in ED LOS following implementation of fast-track initiatives have been demonstrated in other studies from Australia, the UK, Europe, Canada and the USA 4 8 – 14. In one of the few randomised controlled studies of fast track, Kilic et al 8 showed that median ED LOS for fast-track patients was 36 minutes compared with 63 minutes for the control group.…”

Section: Discussionmentioning

confidence: 89%

“…Reductions in ED LOS following implementation of fast-track initiatives have been demonstrated in other studies from Australia, the UK, Europe, Canada and the USA 4 8 – 14. In one of the few randomised controlled studies of fast track, Kilic et al 8 showed that median ED LOS for fast-track patients was 36 minutes compared with 63 minutes for the control group. Given that ED LOS for fast-track patients was just under 2 h, the practicality of the 60-minute target currently in the fast-track criteria is questionable.…”

Section: Discussionmentioning

confidence: 89%

“…There is a number of benefits associated with ED fast track including reductions in waiting times,6 7 decreased ED LOS,4 8 – 14 financial savings,10 increased patient satisfaction8 and decreased left-without-being-seen rates 7 14. Despite the rapid growth of ED fast-track systems in Australia, their impact is poorly understood.…”

mentioning

confidence: 99%

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Effect of emergency department fast track on emergency department length of stay: a case-control study

Considine

Kropman

Kelly

et al. 2008

Emergency Medicine Journal

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.0) for cases (p,0.01). Fast-track patients had a significantly higher incidence of discharge within 2 h (53% vs 44%, p,0.01) and 4 h (92% vs 84%, p,0.01). Conclusions: ED fast track decreased ED LOS for nonadmitted patients without compromising waiting times and ED LOS for other ED patients.Emergency department (ED) fast-track systems ''stream'' patients with non-urgent complaints to treatment in a dedicated area and aim to decrease waiting times and ED length of stay (LOS), reduce ED overcrowding and increase patient and staff satisfaction.1-5 Fast-track systems are designed to improve ED capacity during peak demand from seasonal or diurnal variation in presentations. Fast-track systems are usually staffed by senior medical and nursing personnel underpinned by the notion that senior staff can make timely discharge decisions and that limiting staff running fast track will expedite care by decreasing handovers and fragmentation of care. Detailed analysis of four fast-track models by the Victorian auditor general showed that whereas each fast-track model had similar aims, there was variability as each model was designed to meet local needs.1 All of the fast-track models reviewed were designed to manage single system, non-urgent, uncomplicated complaints and all had dedicated nursing staff; however, there was variability in time of operation, availability of a dedicated area and whether there was dedicated or shared medical staff. 1There is a number of benefits associated with ED fast track including reductions in waiting times, Despite the rapid growth of ED fast-track systems in Australia, their impact is poorly understood. Most published evaluations of ED fast track are limited to singlesite studies using uncontrolled descriptive designs 2 and there is a lack of controlled studies related to ED fast-track outcomes. The aim of this study was to evaluate the effect of ED fast track on ED patient flow using a pair-matched case-control design. The primary outcome measure was ED LOS of fast-track patients. Secondary outcome measures were waiting times and ED LOS of other ED (non-fast-track) patients. METHODS Study designA pair-matched case-control design was used.

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Section: Discussionmentioning

confidence: 89%

Section: Discussionmentioning

confidence: 89%

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Effect of emergency department fast track on emergency department length of stay: a case-control study

Considine

Kropman

Kelly

et al. 2008

Emergency Medicine Journal

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“…All but one patient went home, median waiting time for nursing care was short (23 min) and 85.5% of patients were discharged from ED within 4 h which complies with the Victorian Government Department of Health targets 10 . Previous studies of fast track as an ED demand management system have also shown reductions in ED LOS and high proportion of patients leaving the ED within 4 h 2,5,11–15 …”

Section: Discussionmentioning

confidence: 96%

Rapid intervention and treatment zone: Redesigning nursing services to meet increasing emergency department demand

Considine

Lucas

Martin

et al. 2012

Int J of Nursing Practice

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The impact of emergency nursing roles in demand management systems is poorly understood. The aim of this study was to evaluate emergency nurses' role in a specific emergency department (ED) demand management system: rapid intervention and treatment zone (RITZ). A descriptive exploratory approach was used. Data were collected from audit of 193 randomly selected patient records and 12 h of clinical practice observation. The median age of participants was 31 years, 51.8% were males and 99.5% were discharged home. Nurse qualifications or seniority had no significant effect on waiting time or length of stay (LOS). There were disparities between documented and observed nursing practice. The designation and qualifications of RITZ nurses made little difference to waiting times and ED LOS. Specific documentation and communication systems for areas of the ED that manage large numbers of low complexity patients warrant further research.

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“…A UK study showed that the risk of waiting more than 1 hour to see the doctor decreased by 30% to 50% with increased presence of consultants in the department [61], and a second study demonstrated an increase in the patients seen within 1 hour from 52% to 75% without an increase in staffing [62]. In another study the median length of stay was 36 minutes for fasttracked patients compared with 63 minutes for the control group [63]. This has worked equally well in pediatric units [64].…”

Section: Question 4: In Hospital Eds Experiencing Overcrowding (Settimentioning

confidence: 99%

Emergency Department Overcrowding

Schull

Cooke

2008

Evidence‐Based Emergency Medicine

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Prospective, double-blind, comparative fast-tracking trial in an academic emergency department during a period of limited resources

Cited by 17 publications

References 0 publications

Effect of emergency department fast track on emergency department length of stay: a case-control study

Effect of emergency department fast track on emergency department length of stay: a case-control study

Rapid intervention and treatment zone: Redesigning nursing services to meet increasing emergency department demand

Emergency Department Overcrowding

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